A qualitative study of the experiences of people(with experience of rough sleeping / homelessness)
who were temporarily accommodated in London hotels as part of the 'Everyone In' initiative (March - September 2020).
Dr Stephen Parkin
Research Fellow
National Addiction Centre
The Institute of Psychiatry, Psychology & Neuroscience
Background
COVID-19 and Public Health Responses
(UK, 23 March 2020)
- (First) National Lockdown
- Social Distancing, Social Isolation and Shielding
- ‘Stay at Home, Protect the NHS, Save Lives’
- ‘Everyone In’ initiative
- (England, 26 March 2020)
- Directive for all local authorities inEngland to provide emergencyaccommodation for people currentlyexperiencing rough sleeping orhomelessness
Everyone In
Over 1000 hotels throughout Englandprocured by local authorities (providingtemp accomm for over 15,000 people )
Of which c.65 hotels were located in/aroundLondon (providing temp accomm forapproximately 5,500 people at peak)
Initially meant to be for 12 weeks
… but still running... in a much reducedformat
Everyone In Accommodation:Tiered System of
Provision
1. COVID-Care - accommodatingpeople testing positive for, ordisplaying and reportingsymptoms of, the virus
2. COVID-Protect - accommodatingpeople who are asymptomaticbut considered most vulnerablebecause of their age orunderlying health conditions
3. COVID-Prevent - accommodatingpeople who are asymptomaticand deemed less vulnerable toCOVID-19
01 May 2020
National Addiction Centre,
King’s College London.
Ethical approval granted to conduct a covid-secure study of the Everyone In
initiative at 2 London hotels
“A rapid evaluation of the London hotels initiative for people who
experience rough sleeping”
(NB: An unfunded study with most of the team working on voluntary basis)
The Study:Aim, Methods
and Output
Aim
To evaluate the London hotel initiative for people who experiencerough sleeping from the perspective of people accommodated in twohotels during the COVID-19 pandemic.
Methods
A rapid, longitudinal, qualitative study.
Ten (10) topic-based telephone interviews conducted with eachparticipant at two points in time. Namely:
Stage 1 – five interviews over five days while in the hotel
Stage 2 – five interviews over five weeks after leaving the hotel
Output
Stage 1: June – September 2020 = Report 1 (today’s presentation)
Stage 2: October – December 2020 = Report 2 (not covered today)
Findings: participant
profile (residents)
35 Residents participated in study (33 completed all Stage 1 interviews[n=165]). All with recent experience of rough sleeping.
33/35 from COVID-Protect hotel (2/35 from COVID-Prevent hotel)
Age: 21-75 years old (mean 48 years old)
Ethnicity: 24/35 identified as Black, Asian or other Minority Ethnicgroup
Sex: 7 identified as female, 28 identified as male
Nationality: 11 born UK, 3 born EU, 21 born outside UK/EU (manyinvolved in complex immigration issues: refuge, asylum, visas, expectingdeportation, recent release from detention centre etc.)
Language: More than half spoke English as Foreign Language
Homelessness: range 4 nights – 30 years (most approx. 5 years)
Relationships: Almost all were single, separated, divorced or widowed(few in current relationship)
Education: 10/33 had further/higher education certificates (includingtwo PhDs). 13/33 reported no formal qualifications.
Employment: wide variation of skilled/unskilled experience. Smallnumber of long time unemployed and many unable to work due toimmigration status
Selected Key Messages
Some key messages (lessons learned) …..
Participants
• Findings suggest that people accommodated in the COVID-Protecthotel were likely to be male and unlikely to be British nationals.
• Overall, those in both hotels had diverse support needs (language,legal, financial, physical health, psychological, and emotional) withlimited links to social, health and financial support systems.
• Many did not have long histories of homelessness and were oftenanxious / frightened by sleeping on the streets and in hostels.
Some key messages (lessons learned)
Everyone In Initiative
• It is possible to move people into emergency accommodation quickly (althoughtemporary)
• Participants valued the kindness of the hotel staff, the room facilities, and the warmth,safety and privacy afforded by having their own space
• Participants tended to be grateful for all practical support (including provision ofsmartphones), although many still had unmet needs (relating to health and medicine)
• People were appreciative of the hotel accommodation and reluctant to be critical …
• …. except for the monotony of cold, predictable, food (which caused widespreadcomplaints, dissatisfaction, going hungry, and verbal abuse from catering companyemployees)
Some key messages (lessons learned) …..
COVID-19 Prevention
• The hotels appeared to be successful intervention in terms of protectingresidents from exposure to COVID-19 and created an environment forpeople to minimise social contact
• Participants reported widespread awareness of - and compliance with -COVID-19 guidelines (both in hotel, and outside hotel)
Some key messages (lessons learned) …..
Physical and Mental Health
• Participants reported a wide range of physical health problems which wereoften being treated before they moved into the hotel
• Participants also reported a wide range of mental health problems but did notseem to be well-connected to mental health services before moving into thehotel
• Despite the provision of medical treatment within the hotel, participantscontinued to report untreated mental and physical health problems
• The distribution of free nicotine patches, gum and vaping equipment helpedto reduce some tobacco consumption
Some key messages (lessons learned) …..
Move on to next step accommodation
• Participants tended to have little information about when they would beleaving the hotel and where they would be moving to. This caused stress andanxiety throughout.
• The process of moving out of the hotel became difficult and traumatic formany residents.
• For some, this involved rude awakenings early in the morning and givenone hour’s notice to leave (in transport arranged by the hotel).
• Difficulties and trauma may have been reduced if residents had been givenmore information (location and type) of their move-on accommodation …• …. and more time to prepare and pack on the day of the move.
Do different?Food
Consider other ways of providing meals to include more choice and be appropriate for diverse(medical, religious and cultural) diets, and to consider provision of hot meals on a regular basis.
Provide some opportunity for residents to cook for themselves (or have access to a fridge ormicrowave would be valued).
Support
• Although residents received support and referrals to services while in the hotel, they continued tohave many unmet needs as they departed from the hotel.
• A more coordinated and assertive approach to providing support services would have likely beenappreciated by many residents (especially amongst those who spoke EFL).
Move-on, next step accommodation
• Move on arrangements was made difficult due to many factors beyond the control of the hotel staff,but the uncertainty caused stress and anxiety amongst residents.
• Some of this stress/anxiety would have probably been avoided if staff had been able to:• give residents more information verbally (avoiding letters handed to speakers of EFL)• communicated with residents more regularly and openly about when and where they would be going next.
Safeguarding
Overall, the participant group had contactwith charities and third sector services,some contact with formal health systems,but had limited access to (formal andinformal) social, financial and emotionalsupport systems.
As a group, they were unlikely to seek out orask for any support. The group seem likelyto require outreach (or assertive forms ofassistance) to bring them into services inthe future.
Once contacted, they are likely to begrateful for any help offered.
SomeKnowledge
Gaps
• How did the hotels in the tier system differ? (Were thereany particular models that worked better than others,and if so, how and why)
• Who were housed in the different tiers and who did notreceive an offer of (or refused) accommodation
• How were decisions made regarding those people whowere asked to leave – and by whom? And where did theygo?
• What are residents’ experiences of move-onaccommodation during second (Nov 2020) and third (Jan2021) lockdowns
• What are the views and experiences of Charity Staffworking in the hotels and other staff (security/caterers)during first lockdown?
• What are the implications/expectations for housingpeople experiencing rough sleeping post COVID-19?
Going forward?
Findings presented throughout relate mainly to Report 1 (Life in the Hotel), due to Webinar focus on
‘first lockdown’
Report 2, (Life in the month after the Hotel), portraysa different picture of the residents’ lives when theyhad moved on to next step accommodation in thecommunity (or to other hotels/hostels).
Selected messages from Report 2 follow in next slide(Neale et al, 2021, Experiences of being housed in aLondon hotel as part of the Everyone In initiative. Part2: Life in the month after leaving the hotel. pp23-25 )
‘Follow-up interviews revealed that these same residents were often critical of theirmove-on accommodation. Moreover, the extreme nature of some of theircomplaints suggested that some were being housed in accommodation that mightnot be deemed ‘suitable’ according to the homelessness code of guidance for localauthorities.’ p23
‘The follow-up interviews indicated that this good work was often unravelling withina month of people leaving the hotel. In particular, participants reported that theirphysical and mental health were deteriorating, and there were signs that, withoutproactive hotel support, some were losing contact with services ….’ p.23
Overall….. ‘our findings provide a glimpse into what can be achieved when peoplewho are homeless are offered warmth, safety and care; and, also, how rapidly gainscan be lost if we fail to continue to invest’ p.25
Acknowledgements
Thanks to all study participants for sharing their views andexperiences during interviews.
Thanks to staff from two charities who managed the two hotels inthe study and who facilitated access to residents.
Basic funding for the research (to cover mobile phones and phonecalls for the research team, printing of information sheets andconsent forms, and reimbursements for the study participants) wasprovided by the National Institute for Health Research (NIHR)Maudsley Biomedical Research Centre (BRC) at South London andMaudsley NHS Foundation Trust and King’s College London.
The study team:
Alice Bowen, Eileen Brobbin, Sam Craft, Colin Drummond, Georges-Jacques Dwyer, Emily Finch, Juliet Henderson, Laura Hermann, MikeKellehar, Landon Kuester, Rebecca McDonald, Stephen Parkin, PollyRadcliffe, Emmert Roberts, Deborah Robson, John Strang, RichardTurner, Joanne Neale* and Nicola Metrebian*
(*Joint Principal Investigators)
The views expressed in this presentation and associated reports arethose of the presenter/authorship team and are not necessarilythose of the NHS, the NIHR or the Department of Health and SocialCare
Further information
Report 1 (Life in the hotel)
Report 2 (Life in the month after leaving the hotel)
Both available at:
https://osf.io/rt7j9/
Enquiries and information about this presentation:
Joint Principal Investigators of the study:
